Frequently Asked Questions...

For Consumers: Communication and knowledge are important elements of any relationship. When it comes to health decisions, patients and physicians must actively work together.

The Tri-State Independent Physicians Association, Inc. would like to help you make informed decisions about your healthcare. We believe it's important for consumers to understand as much as possible about today's complex healthcare environment and the role the IPA and its participating physicians play.

What is managed care?

Originally the term "managed care" referred collectively to prepaid health plans. Today employers and consumers face a wide array of choices when it comes to purchasing healthcare services. The emergence of managed care has created a virtual alphabet soup for consumers to deal with. The terms "health maintenance organization" (HMO) and "preferred provider organization" (PPO) have become part of our vocabulary, but managed care plans actually come in a variety of different flavors today.

Managed care plans range in type from "more restrictive" to "less restrictive" models. The lines between types of managed care plans are becoming blurred. A common thread among all managed care plans, however, is that they seek to combine the financing and delivery of health care services.

What is an IPA?

IPA stands for "independent physicians association". Independent physician means physicians in private practice, in contrast to physicians who are employees of a corporation, such as a hospital or HMO. Physicians join IPAs to gain the advantage of group purchasing, recruitment, managed care contracting, shared information systems, etc.

Because IPA physicians are in private practice, they are able to see private patients as well as patients who are covered by the managed care plans that an IPA contracts with. This is good for consumers for several reasons. One, it helps to keep healthcare more affordable, by allowing health plans to take advantage of resources that are already available in the community.

Another advantage to consumers is that, since IPA physicians are in private practice, they can see other members of your family even if they aren't covered by your health plan. On the other hand, if you're required to see a physician who works exclusively for an HMO, the rest of your family may have to go to a different physician.

Finally, with a large IPA, it's likely that you'll be able to enroll in an IPA-based health plan and still be able to continue seeing the same family physician you've had all along.

What is credentialing and why is it important?

At its most basic, credentialing means the process of checking a physician's background and qualifications. At Tri-State IPA it means much more.

When a physician applies for membership with Tri-State IPA, our credentialing staff performs verification of the following:

  • Education - when, where, degrees, etc.
  • Employment history and experience
  • Hospital privileges
  • Certification in various medical specialties
  • Licenses to practice medicine
  • Liability insurance coverage
  • Disciplinary actions, if any, including malpractice claims
  • Peer references - can other physicians who have worked closely with the applicant attest to his or her competence?

Only after all the items have been satisfactorily documented is a physician considered for membership in Tri-State IPA. And every two years the items that are subject to change are verified again, in order for a member to remain in Tri-State IPA.

Credentialing procedures are based upon National Committee for Quality Assurance (NCQA) criteria and reviewed periodically by the health plans we work with to ensure that we're performing to the highest standards.

Why is this important to consumers? It simply means you can depend on Tri-State IPA physicians to provide the finest medical care in your community.